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Historical Review of The Development, Technique,
Compression Cardiopulmonary Resuscitation as a
Copy Right@ Leonard Ranasinghe
This work is licensed under Creative Commons Attribution 4.0 License
AJBSR.MS.ID.002302.
American Journal of
Biomedical Science & Research
www.biomedgrid.com
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Mini Review
Ma V*
1Fourth-year medical student, California Northstate University College of Medicine, California, USA
2Professor and clerkship director of emergency medicine, California Northstate University College of Medicine, California, USA
Leonard Ranasinghe, Professor and clerkship director of emergency medicine, California Northstate
University College of Medicine, Elk Grove, California, USA.
To Cite This Article: Ma V, Sauer A
Abdominal Compression Cardiopulmonary Resuscitation as a Promising Adjunct with Standard CPR. Am J Biomed Sci & Res.
DOI: 10.34297/AJBSR.2022.17.002302
R August 23, 2022; August 29, 2022
Mini Review
Interposed abdominal compression cardiopulmonary
resuscitation, henceforth referred to as IAC-CPR, is an adjunct to
standard CPR (S-CPR) according to American Heart Association
(AHA) guidelines since 1992. Compared to other CPR adjuncts
like high-frequency CPR, Active Compression Decompression CPR
(ACD-CPR), vest CPR, mechanical (piston) CPR, Simultaneous
Compression Decompression CPR (SCD-CPR), Phased Thoracic
Abdominal Compression Decompression CPR (PTACD), and invasive
CPR, IAC-CPR is widely accepted to be the least expensive, simplest,
and most studied adjunct. IAC-CPR incorporates additional manual
rhythmic compression of the region between the umbilicus and
xiphoid process of the abdomen during the relaxation, or diastolic,
by increasing venous return to the heart through IVC compression
while simultaneously providing aortic counterpressure, ultimately
increasing coronary perfusion [2]. It is an oft-forgotten method of
demand limits its feasibility in a critical situation. The technique
itself requires 3 medical personnel trained in its use, one for airway,
one for chest wall and the other for abdominal compressions. As if
the demand on the number of medical staff needed weren’t enough,
IAC-CPR also requires precise compression timing and depth for
appropriate success.
Thus, the question clearly arises: why even bother? It may seem
foolish to devote additional manpower and training for something
that is rarely used to begin with. With that in mind, this mini-review
will serve to provide a brief overview of past and present literature
surrounding its promise as well as any implications this may have
on the future deliverance of CPR in the Basic Life Support (BLS)
protocol.
associates small animal study in 1982 in which the technique
improved arterial pressure, perfusion, and cardiac output
compared to S-CPR in dog models [2]. The study aimed to explore
further results from the 1967 Harris and associates study [3]
showing positive outcomes with continuous compression of the
extremities and shunting to more vital organs like the brain and
heart. Additionally, compression of the abdominal aorta increases
and brain circulation. However, the study had limited utility as
it differed in technique from modern IAC-CPR, with constant,
not alternating, pressure being applied to the umbilicus. Upper
abdominal pressure was also not recommended as 2 of the 6 dog
models developed liver lacerations. A subsequent study by Redding
American Journal of Biomedical Science & Research
Am J Biomed Sci & Res Copy@ Leonard Ranasinghe
19
in 1971 [4] again found improved carotid circulation and survival
with continuous pressure in animal models, via blood pressure
cuff around the abdomen, with no difference in liver laceration
incidence between this technique and traditional CPR. Ralston and
associates thus believed liver lacerations occurred in part due to
the inability of the liver to recede if constant abdominal pressure is
applied [2]. These initial studies ultimately sparked further interest
In the late 1980s and early 1990s, research was conducted on
A small randomized prospective study found a strong association
between higher cardiac output and IAC-CPR [5]. The study of
33 patients used end tidal PCO2 (ETPCO2) as a parameter in
comparison of IAC-CPR to S-CPR. Patients were initially given either
IAC-CPR (16) or S-CPR (17) and switched to the other technique
after 20 minutes of resuscitation. On average, ETPCO2 was 17.1
mm Hg in patients receiving IAC-CPR compared to 9.6 mm Hg
receiving S-CPR, with a difference of 78% (P=.001). ROSC was also
higher in the IAC-CPR group at 30% compared to 6%, although not
possible confounding bias exists as 6 of the 16 patients who initially
received IAC-CPR were successfully resuscitated compared to 3 of
17 in the S-CPR group before 20 minutes when the techniques were
switched. In 1992, Sack and coworkers conducted a randomized
controlled trial of 103 patients comparing IAC-CPR to S-CPR, with
abdominal compressions set at a rate of 80/min to 100/min [6]. The
three endpoints were return of spontaneous circulation (ROSC),
24 hour survival post-CPR, and survival to hospital discharge.
compared to control, at 51% to 27% respectively (P=.007) and
greater rate of survival to hospital discharge at 25% to 7%
respectively (P=.02). Of note 17% vs 6% respectively survived to
hospital discharge and were neurologically intact, although these
CPR improving survival following in-hospital cardiac arrest and
built a strong foundation for holistic analyses of results.
Evidence-based review of data prior to 2003 of pre-hospital and
in-hospital resuscitations including studies mentioned previously
S-CPR (P<.01). Exclusive focus on in- hospital practice found even
mechanical models found generally 50-100% improvement in
circulation and coronary perfusion with IAC-CPR.
IAC-CPR has also been observed to potentially have a wider
range of applicability. One case report by McClung and Anshus
The patient in question demonstrated full neurologic recovery
whereas initial use of traditional CPR had been failing, suggesting
that IAC-CPR may outperform standard CPR in patients with both
normal and abnormal anatomy during in-hospital arrests [8].
next to no disadvantages of using IAC- CPR. Observed potential
upsides include improved venous return, decreased incidence of
activation prior to intubation. There has also been no observation
of increased rates of emesis or aspiration of gastric contents. One
may reasonably assume that abdominal trauma is of great concern
thoracic trauma - however, there were 0 cases of abdominal trauma
noted in over 200 subjects across 8 separate trials [9].
compared to its traditional counterpart for in-hospital arrests - there
of usability. It continues to remain limited by its sheer technical
suitable solutions to address these shortcomings. We believe that
the promising nature of this technique warrants further study and,
indeed, would not be surprised to see its use grow in popularity
over the coming years.
None.
References
1. (2000) Advanced Cardiovascular Life Support; Devices to Assist in
Circulation. AHA Journals 102: I-105-I-111.
2. Ralston Sandra H, Babbs Charles F, Niebauer Mark J (1982)
Cardiopulmonary resuscitation with interposed abdominal compression
in dogs. Weldon School of Biomedical Engineering Faculty Publications
Pp: 38.
3.
during cardiopulmonary resuscitation. Anesthesiology 28(4): 730-734.
4. Redding JS (1971) Abdominal Compression in Cardiopulmonary
Resuscitation. Anesth Analg 50(4): 668- 675.
5. Ward KR, Sullivan RJ, Zelenak RR, Summer WR (1989) A comparison
of interposed abdominal compression CPR and standard CPR by
monitoring end- tidal PCO2. Ann Emerg Med 18(8): 831-837.
6. Sack JB, Kesselbrenner MB, Bregman D (1992) Survival from in-hospital
cardiac arrest with interposed abdominal counterpulsation during
cardiopulmonary resuscitation. JAMA 267(3): 379-385.
7. Babbs Charles F (2003) Interposed Abdominal Compression CPR: A
Comprehensive Evidence Based Review. Weldon School of Biomedical
Engineering Faculty Publications Pp: 63.
8. McClung, Christian D, Anshus AJ (2015) Interposed Abdominal
Compression CPR for an Out-of-Hospital Cardiac Arrest Victim Failing
Traditional CPR. Western Journal of Emergency Medicine: Integrating
Emergency Care with Population Health 16(5).
9.
and complications of interposed abdominal compression during
cardiopulmonary resuscitation. Acad Emerg Med 1(5): 490-497.
